Meet the Instructors

Antoine Flahault

Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)University of Geneva and Université Paris Descartes – Sorbonne Paris Cité

Rafael Ruiz De Castañeda

Institute of Global Health - Faculty of MedicineUniversity of Geneva

Defeating Ebola Together Week 4: The Response from Africa and the World
"Duties of the WHO and its Member Countries under the International Health Regulations"

Hello -- I'm going to explain how the

International Health Regulations are currently being applied

in West Africa in response to the Ebola epidemic.

The International Health Regulations, or IHR,

are a legal instrument adopted by all of the WHO's member countries in 2005,

in effect as of 2007, and aiming to

ensure that each member country has the capabilities to prevent,

detect and respond to events of international significance,

-- i.e., events liable to propagate internationally --

in a measured and controlled manner,

that is, without impeding international travel or trade.

Let's go into a little more detail.

First, the countries that have adopted the IHR

are required to implement certain capabilities.

They must possess a legislative and political framework

through which to put into effect the necessary preparations and

monitor their response.

They need laboratories, human resources,

methods to communicate about risks and ensure coordination.

This pertains to anything capable of spreading internationally:

infectious diseases, food-related diseases, zoonoses,

and chemical and radiological risks.

These capacities must be implemented at the local,

intermediary and central levels.

In practice, what does this mean?

To detect diseases, you need a

highly operational laboratory for rapid diagnosis;

information must travel directly from any individual peripheral

healthcare facility to a centralized body,

and then passed on to the WHO.

Before the IHR, only certain designated diseases

required the WHO to be notified.

Now, risk analysis is carried out by each country, and

declaration is no longer systematic or mandatory, but based on specific criteria.

First criteria: can the disease potentially have severe consequences for public health?

Is it an unusual or unexpected event?

Is there a risk of international propagation?

And is there a chance that travel and trade will have to be restricted?

Clearly, Ebola fits all four criteria.

It's unexpected, severe, liable to spread internationally,

and it could lead to travel and trade restrictions.

The WHO was thus notified in March of 2014.

The WHO's role, then, was to assess the risk and

provide support to the affected countries.

Countries have prepared themselves ahead of time; the WHO provides support when comes the time to respond.

Legally, the IHR gives the WHO

the right to form an emergency committee

whenever the situation appears to be an international public health emergency,

that is, an event whose propagation would create a risk for other countries

and requires coordinated international action.

On August 8, all the conditions having been met,

the WHO's Director-General,

in response to the rapid increase of cases and the risk of international propagation,

convened the IHR's Emergency Committee.

The Committee is made up of experts who,

based on their specialized knowledge, advise the Director-General.

The Director-General, on the basis of

the information and advice received from these experts,

declared the Ebola epidemic to be an international public health emergency.

The Committee then issued a certain number of recommendations.

Why are these recommendations important?

First, they indicate to the countries in question

the measures that must be effected to prevent international propagation.

In this case, the Committee asked each country to declare

a state of national emergency; asked each country's president to

get personally involved; and asked for certain measures to be taken

to screen departing travelers in airports.

These measures apply, first and foremost, to the countries concerned, but recommendations were also issued to

prevent international travel and trade from being impaired, which would impose a double penalty on those countries.

The WHO was very clear: the Director-General stated

that, as a rule, travel should not be forbidden.

This is very important because communication channels to and from these countries must stay open

so that humanitarian workers can provide aid,

and also to minimize the crisis' economic impact.

Unfortunately, every country does not always

follow the WHO's recommendations.

For instance, we've seen countries close their borders

or refuse to issue visas to travelers coming from these countries.

What does the WHO do in such cases?

We maintain a dialogue with countries who do this and

we ask them to justify, in terms of public health, why such measures were taken.

If necessary, we explain that such measures are not

justified in terms of international public health.

This kind of dialogue allows us to limit the impact on the affected countries.

The goal, of course, is an appropriate response in order to bring the epidemic under control as soon as possible, but this must be done at the international level.

The primary goal of the International Health Regulations is to ensure that countries have response capabilities

ahead of time, because once you're in a state of emergency,

mobilizing all the actors and responding as planned can be very difficult.

Prevention; development of response capabilities; making sure the country has

the right labs and well-trained personnel; effective communication about risks

-- all this should be ready before the need for a rapid, and hopefully effective, response arises.